Empowering the Public for Better Health and Health Outcomes Dr. Patrick Doorley

Empowering the Public for Better Health and Health Outcomes

Dr. Patrick DoorleyNational Director of Population Health, HSE

The Vision

• A health system that supports and encourages you and your family to achieve your full health potential - Quality and Fairness 2001

Empowering the Public for Better Health and Health Outcomes, Dr. Patrick Doorley, 19th May 2005

How the public can be empowered for better

health and health outcomes

• Self Mangement of Chronic Disease• Health Promotion • Planning for better health outcomes• Health Public Policy


Community Action

• Ottawa Charter, 1986– Identified the need for strengthening

community action – recognised that communities will achieve better health status themselves


The Health Strategy Recommended

in Relation to Travellers

• The development in consultation with Traveller groups of health education programmes specifically for Travellers

• The development of models of Traveller participation in health promotion and prevention

• That health boards make special arrangements to encourage Traveller use of health services


MHB Objectives for Travellers Health

• To assess possible Travellers Health needs• To enable Travellers to have more control

over factors which influence their health• To promote healthy lifestyles• To promote the best healthcare and uptake

of important preventive services by Travellers

• To act as advocates for improvement in– Travellers accommodation– Their general physical environment– Other services which effect Travellers’ Health


MHB Pilot Primary Health Care

Project for Travellers

• A joint 4 year pilot project between the MHB and Tullamore Travellers Movement to develop competent Traveller health workers who would be leaders in their own community in promoting health


Capacity Building

• Pre-training phase for Traveller healthcare workers – supported by FÁS

• Building on existing skills– Personal development– Health training– Increasing awareness of Travellers Health– Facilitation and Presentation Training– Developing planning skills

• Evaluation and review


Outcome

• 7 Traveller health workers funded by HSE Midland• Improved knowledge among travellers of health

services available• Health promotion programmes – child safety,

smoking cessation, diabetes, cardiovascular health

• Improvement in uptake of preventive services – eg. dental, immunisation

• Travellers assessing own health needs and discussing with managers


Other applications of Peer Led approach

• Asylum seekers• Migrants health• Older people• Childhood adolesent health• Community Development Projects


Self Management ( 1 )


Hospital

Care

Primary, Community

and Continuing Care

Public Health

Self Management



Public Health

Self Management

Primary, Community and Continuing Care

Hospital Care


Programmes improve health status, healthcare utilisation• Arthritis • Back pain • Chronic disease

Lorig, K, Holman Halsted Stanford University Patent Education Centre



Diabetes Self Management • UK National Service Framework for Diabetes• US National Standards for Diabetes Self

Management Education Programme established criteria

• Self Management programmes improve control, decrease amputation rate, reduce costs and hospitalisation

National Standards for Diabetes Self Management Education Programme

( Lecture Review ) Revised 2002


Outcome (5yr Survival) Hospital Cancer Care

• Centralisation• Specialisation• Multidisciplinary Teams• Audit• Volume Outcome Relationship Cancer Care

– Breast– Colon– Rectal– Breast– Testicular– Pancreas– Oesophagus


Breast Cancer: Experience in Ireland

• Policy document 2000 – Minimum 100 new cases per unit year– Minimum 50 new cases per surgeon per annum

• 2005 – 60% surgeons do less than 10 procedures per year

• Poliferation of small units– Political– Public– Professional


How Might Health Reforms Help

• Unitary System• Better evidence, better info for the public• Regional health offices – political and

public interface provide opportunity for dialogue

• Health Information and QualityAuthority


Public Health Tobacco Acts (2002, 2004)

• Enlosed workplaces smoke-free offices, shops, factories, bars, restaurants, other enclosed workplaces smoke-free

• Aim:•To protect workers and the public

from health consequences of passive smoking


• Public were given facts – also some untruths

• Prolonged comprehensive debate• Mobilised public opinion – including

smokers• Public support for ban increased over

time including smoker support


Allright Report

• Exposure to second hand smoke causes– Cancer– Heart Disease– Repiratory Disease– Other illnesses


OTC Review of Smoking Ban

• 93% think law is good idea including 80% smokers• 96% believe law is successful including 89%

smokers• 98% believe workplaces are healthier• Air quality has improved• Levels of CO have decreased in non-smoking bar

workers• 96% indoor workers report working in smoke free

environment• 94% workplaces inspected are smoke-free• National New Year’s Poll - smoke free law voted

No. 1 “high” of 2004


Conclusions

• Overwhelming public support• Public are empowered• Evidence of health benefit• Public clearly know their rights• Public can be assured that their

rights will be vindicated• Public are making smoking ban work


Other Public Health Policies Which Might Be

Empowering

• Sales of cigarettes to minors• Obesity – parents feel disempowered

because of advertising of junk food, vending machines in schools

• Alcohol – implementing a public health approach to alcohol (Strategic Task Force on Alcohol 2002, Revised 2004 )

• Speed Limits


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Empowering the Public for Better Health and Health Outcomes Dr. Patrick Doorley

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